[Prophylactic amnion infusion during labor. Apropos of 195 cases].
OBJECTIVE
To show that intrapartum prophylactic amnioinfusion in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial.


METHODS
From March 1st, 1993 until December 31st, 1996, 6845 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (118 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2)(77 patients) were included. Each group was compared with a historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age, and duration of labor. Statistical analysis was performed using the Student's t test and the Fisher's exact test when appropriate with a level of significance of p < 0.05.


RESULTS
The mean infused volume was 883 ml in G1 and 751 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (14% versus 25%, p < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (5% versus 18%, p < 0.02). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also find a difference between G2 and CG2 (5% versus 14%) which was not significant. No neonatal or maternal adverse effects happened in this short study.


CONCLUSIONS
Amnioinfusion is easy to perform during labor in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic amnioinfusion performed in case of oligohydramnios and abnormal fetal heart rate.
De Meeus
J B
JB
Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Jean-Bernard, CHU La Milétrie, Poitiers.
Magnin
G
G
Vequeau
V
V
Bascou
V
V
d'Halluin
G
G
D000328:Adult; D000367:Age Factors; D000650:Amnion; D000653:Amniotic Fluid; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000628:therapy; D005440:Fluid Therapy / Q000379:methods*; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D007743:Labor, Obstetric; D008470:Meconium; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control; D007744:Obstetric Labor Complications / Q000628:therapy*; D016104:Oligohydramnios / Q000628:therapy*; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors
L'amnio-infusion prophylactique au cours du travail. A propos de 195 cas.